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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198020176
Report Date: 09/15/2022
Date Signed: 09/16/2022 10:55:45 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2022 and conducted by Evaluator Crystal Green
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220727092629
FACILITY NAME:KIDSZONE PRESCHOOL ACADEMYFACILITY NUMBER:
198020176
ADMINISTRATOR:LIZETTE PIZZAROFACILITY TYPE:
850
ADDRESS:1206 LINCOLN AVETELEPHONE:
(626) 345-5922
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:33CENSUS: 25DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yvonne WithersTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Reporting Requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced complaint follow-up inspection. Upon arrival, Licensing Staff met Licensee Yvonne Withers. Due to COVID- 19 precautionary measures, individuals present during inspection wore appropriate personal protective equipment. Census was taken.

The allegation states that the facility did not meet reporting requirements. Reporting Party (RP) alleges that an incident at the facility resulted in the fire alarm being activated, resulting in the facility having to conduct an emergency evacuation. During this investigation, Licensing staff conducted interviews with the staff. It was confirmed during the interviews that an incident occurred at the facility on 07/26/2022, around 1:30 pm, during nap time, that resulted in the fire alarm being activated. However, the department did not receive an unusual incident report in a timely manner. During the investigation, Licensing staff obtained a written report of the incident.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2022 and conducted by Evaluator Crystal Green
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220727092629

FACILITY NAME:KIDSZONE PRESCHOOL ACADEMYFACILITY NUMBER:
198020176
ADMINISTRATOR:LIZETTE PIZZAROFACILITY TYPE:
850
ADDRESS:1206 LINCOLN AVETELEPHONE:
(626) 345-5922
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:33CENSUS: 25DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yvonne Withers TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
Lack of Supervision
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Crystal Green conducted an unannounced complaint inspection to investigate the allegation above. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Upon arrival licensing staff met with License, Yvonne Withers. Census taken.

During the course of this investigation, Licensing staff conducted interviews. Based on the information obtained from the interviews, at this time there is not enough evidence to support the above allegations. Therefore, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, the above allegations are deemed unsubstantiated. No citation is being issued during today’s inspection.

Exit Interview conducted with Licensee, Yvonne Withers. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20220727092629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2022
Section Cited
CCR
101212
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d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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Per Licensee, A staff meeting was held 09/09/2022 to train staff on Reporting Requirements. LPA requested and obtained a copy of the sign in sheet for the staff meeting.
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The requirement is not met as evidenced by disclosures made by staff during interviews conducted. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20220727092629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176
VISIT DATE: 09/15/2022
NARRATIVE
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Based on interviews conducted during this investigation, the above allegation is substantiated at this time. California Code of Regulations (Title 22, Division & Chapter) relating to this allegation has been cited on LIC 9099-D.

An exit interview was conducted with the Licensee, Yvonne Withers. The Licensee was provided a copy of their appeal rights (LIC 9058), and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4